S&C QCOR ASC 2567s
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ASCs 2567s
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Time Interval

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Provider Characteristics

Use these filters if you want to limit the report to providers that have certain characteristics. To select more than one option, hold down the Ctrl (individual point-and-click) OR Shift keys (select through a range) while you click on the additional desired option(s).

Survey Type & Deficiency Tags

Use these filters if you want to limit the reports to providers on specific survey types, or to reports that were cited for specific ASC deficiency tags and tag types. To select more than one option, hold down the Ctrl (individual point-and-click) OR Shift keys (select through a range) while you click on the additional desired option(s).

CCN and Facility Name

Use these filters if you know the name (or partial name) of the facility you are searching for, or the CMS Certification Number (CCN) for the facility you are searching for.

Other Survey Characteristics

Select one of the options below to filter by surveys that cite deficiencies or by surveys that are deficiency-free. By default, only surveys that cite deficiencies are displayed. Selecting "All" displays all surveys.

CMS Certification Number Facility Name Address City State CMS Region Date of CMS Survey Survey Event ID Survey Type Statement of Deficiencies Report
▼ 50C0001192 Pacific Cataract & Laser Institute 9598 Mickelberry Rd Nw Silverdale WA 10 (Seattle) 07/11/2023 5FEC1-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
Q0040 GOVERNING BODY AND MANAGEMENT Condition
Q0180 PHARMACEUTICAL SERVICES Condition
E0039 EP Testing Requirements Standard
Q0101 PHYSICAL ENVIRONMENT Standard
Q0181 ADMINISTRATION OF DRUGS Standard
▼ 50C0001192 Pacific Cataract & Laser Institute 9598 Mickelberry Rd Nw Silverdale WA 10 (Seattle) 07/11/2023 5FEC1-L1 Recertification
Deficiency Tag Deficiency Description Tag Type
K0000 INITIAL COMMENTS Memo
K0222 Egress Doors Standard
K0355 Portable Fire Extinguishers Standard
K0521 HVAC Standard
K0711 Evacuation and Relocation Plan Standard
K0913 Electrical Systems - Wet Procedure Locations Standard
K0921 Electrical Equipment ? Testing and Maintenance Requirements Standard
K0933 Features of Fire Protection ? Fire Loss Prevention Standard
▼ 50C0001192 Pacific Cataract & Laser Institute 9598 Mickelberry Rd Nw Silverdale WA 10 (Seattle) 11/01/2018 5CIL21 Recertification
Deficiency Tag Deficiency Description Tag Type
K0000 INITIAL COMMENTS Memo
K0223 Doors with Self-Closing Devices Standard
K0353 Sprinkler System - Maintenance and Testing Standard
K0761 Maintenance, Inspection & Testing - Doors Standard
▼ 50C0001192 Pacific Cataract & Laser Institute 9598 Mickelberry Rd Nw Silverdale WA 10 (Seattle) 10/25/2018 5CIL11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
E0023 Policies/Procedures for Medical Documentation Standard
Q0101 PHYSICAL ENVIRONMENT Standard
Q0104 SAFETY FROM FIRE Standard
Q0141 ORGANIZATION AND STAFFING Standard
Q0162 FORM AND CONTENT OF RECORD Standard
Q0201 LABORATORY SERVICES Standard
Q0231 PRIVACY Standard
Q0241 SANITARY ENVIRONMENT Standard
Q0245 INFECTION CONTROL PROGRAM Standard
▼ 50C0001196 Southwest Washington Regional Surgery Llc 200 Ne Mother Joseph Place, Suite 1100 Vancouver WA 10 (Seattle) 04/03/2024 626D7-H1 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
E0001 Establishment of the Emergency Program (EP) Condition
Q0240 INFECTION CONTROL Condition
E0026 Roles Under a Waiver Declared by Secretary Standard
E0037 EP Training Program Standard
E0039 EP Testing Requirements Standard
Q0064 STANDARD LEVEL TAG FOR SURGICAL SERVICES Standard
Q0104 SAFETY FROM FIRE Standard
Q0110 EMERGENCY PERSONNEL Standard
Q0162 FORM AND CONTENT OF RECORD Standard
Q0233 SAFETY - ABUSE/HARASSMENT Standard
Q0241 SANITARY ENVIRONMENT Standard
Q0242 INFECTION CONTROL PROGRAM Standard
▼ 50C0001196 Southwest Washington Regional Surgery Llc 200 Ne Mother Joseph Place, Suite 1100 Vancouver WA 10 (Seattle) 04/03/2024 626D7-L1 Recertification
Deficiency Tag Deficiency Description Tag Type
K0000 INITIAL COMMENTS Memo
K0291 Emergency Lighting Standard
K0321 Hazardous Areas - Enclosure Standard
K0325 Alcohol Based Hand Rub Dispenser (ABHR) Standard
K0345 Fire Alarm System - Testing and Maintenance Standard
K0353 Sprinkler System - Maintenance and Testing Standard
K0355 Portable Fire Extinguishers Standard
K0511 Utilities - Gas and Electric Standard
K0521 HVAC Standard
K0531 Elevators Standard
K0712 Fire Drills Standard
K0761 Maintenance, Inspection & Testing - Doors Standard
K0914 Electrical Systems - Maintenance and Testing Standard
K0918 Essential Electrical Systems ? Generator or Alternate Source Standard
▼ 50C0001196 Southwest Washington Regional Surgery Llc 200 Ne Mother Joseph Place, Suite 1100 Vancouver WA 10 (Seattle) 01/19/2022 UC0411 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial Comments - Not a Deficiency Citation Memo
E0004 Develop EP Plan, Review and Update Annually Standard
E0024 Policies/Procedures-Volunteers and Staffing Standard
E0026 Roles Under a Waiver Declared by Secretary Standard
Q0062 ANESTHETIC - DISCHARGE Standard
Q0104 SAFETY FROM FIRE Standard
Q0121 MEMBERSHIP AND CLINICAL PRIVILEGES Standard
Q0141 ORGANIZATION AND STAFFING Standard
Q0162 FORM AND CONTENT OF RECORD Standard
Q0241 SANITARY ENVIRONMENT Standard
Q0242 INFECTION CONTROL PROGRAM Standard
▼ 50C0001197 Victor R Michalak Md Dba 295 Ne Gilman Blvd #101 Issaquah WA 10 (Seattle) 06/02/2025 65C65-L1 Recertification
Deficiency Tag Deficiency Description Tag Type
K0000 INITIAL COMMENTS Memo
K0131 Multiple Occupancies Standard
K0211 Means of Egress - General Standard
K0291 Emergency Lighting Standard
K0293 Exit Signage Standard
K0345 Fire Alarm System - Testing and Maintenance Standard
K0346 Fire Alarm System - Out of Service Standard
K0353 Sprinkler System - Maintenance and Testing Standard
K0354 Sprinkler System - Out of Service Standard
K0355 Portable Fire Extinguishers Standard
K0521 HVAC Standard
K0711 Evacuation and Relocation Plan Standard
K0712 Fire Drills Standard
K0741 Smoking Regulations Standard
K0761 Maintenance, Inspection & Testing - Doors Standard
K0914 Electrical Systems - Maintenance and Testing Standard
K0920 Electrical Equipment ? Power Cords and Extension Cords Standard
K0921 Electrical Equipment ? Testing and Maintenance Requirements Standard
K0926 Gas Equipment - Qualifications and Training Standard
▼ 50C0001197 Victor R Michalak Md Dba 295 Ne Gilman Blvd #101 Issaquah WA 10 (Seattle) 09/29/2020 1J2F11 Focused Infection Control, Other-Fed
Deficiency Tag Deficiency Description Tag Type
Q0000 Initial Comments - Not a Deficiency Citation Memo
Q0242 INFECTION CONTROL PROGRAM Standard
Q0245 INFECTION CONTROL PROGRAM Standard
▼ 50C0001197 Victor R Michalak Md Dba 295 Ne Gilman Blvd #101 Issaquah WA 10 (Seattle) 01/31/2019 0VTQ21 Recertification, Sample Validation
Deficiency Tag Deficiency Description Tag Type
K0000 INITIAL COMMENTS Memo
K0345 Fire Alarm System - Testing and Maintenance Standard
K0353 Sprinkler System - Maintenance and Testing Standard
K0354 Sprinkler System - Out of Service Standard
K0712 Fire Drills Standard
K0761 Maintenance, Inspection & Testing - Doors Standard
K0914 Electrical Systems - Maintenance and Testing Standard